Fish Consumption for the Adult Population of Hawai'i, Collected with a Self-Reported Household Survey.

The population of Hawai'i has traditionally been high in average fish consumption when compared to the national average. However, information is lacking on patterns of fish consumption among subpopulations. Data on fish consumption in the last 30 days from 11,293 adults was collected with the use of the Hawai'i Health Survey (an annual telephone survey of households and household members) during the years 2007 and 2008 and weighted to represent the adult population of Hawai'i. The US Department of Agriculture's, Environmental Protection Agency, and the United States Food and Drug Administration, recommend 8-12 ounces of fish per week for associated health benefits. Present estimates of fish consumption were skewed to the right (mean 10.5 and median 7.9 ounces) with some adults eating large amounts of fish per day and frequently. It may be of concern, given high amounts of methylmercury in select fish, that 13.7% of adults were eating fish 20 or more times per month. In addition, the serving size increased with increasing number of times per week fish was eaten. The subpopulation variables examined included age, sex, marital status, education, ethnicity, poverty, and demographics representing the adults of Hawai'i. The prevalence of adults consuming 8 or more ounces was highest for other than Honolulu counties, men, ages 18-74, married, with at least one year of college, Filipino and Native Hawaiian ethnicities (White, Japanese, Chinese, and All Others were also examined), employed, and adults living with higher income levels (lower poverty). However, only an estimated 46.9% of adults in Hawai'i were eating the eight or more ounces of fish weekly. Prevalence was lowest for women, Chinese, age >74 years, and the City and County of Honolulu. Adults who rated their general health better (excellent/good compared to fair/poor) were more likely to consume 8 or more ounces of fish per week, significantly for men. Men who rated their physical health higher and their mental health higher (via Optum SF™ Health Surveys) were associated with higher prevalence of consuming 8 or more ounces of fish per week. Higher consumption of the beneficial omega-3 fatty acids associated with fish low in methylmercury needs to be encouraged for those not meeting the recommended ounces of fish per week, particularly women, Chinese, older age groups, and adults living below the poverty level.

Alterations in Hepatic Lipid Metabolism, and their Relation to Dietary Macronutrients in Pediatric Nonalcoholic Fatty Liver Disease.

Nonacoholic fatty liver disease (NAFLD) is a common complication of pediatric obesity in which diet is a major factor in causation and the cornerstone of treatment. In this review, the alterations in hepatic lipid metabolism that contribute to pediatric NAFLD, and impact of dietary proteins, carbohydrates, and fats on hepatic fat metabolism and NAFLD are described. Lastly, dietary recommendations for achieving changes in macronutrient intakes that can be beneficial in the treatment of NAFLD are provided.

Fish intake by adolescents is related to nutrient intake but not lifestyle factors.

Nutrition during adolescence influences long-term health outcomes. Consumption of fish has many health benefits, yet few studies have investigated associations between fish intake and nutrient intake and lifestyle factors in adolescents. A cross-sectional study utilizing 24-hour dietary recalls obtained by in-person interviews investigated relationships between fish intake and demographic characteristics, nutrient intake, and lifestyle factors among adolescents (mean age = 15.5 years). Height, weight, and self-administered survey data were collected from 839 high school students who took part in the 2000-2004 Hawaii Nutrition Education Needs Assessment survey. About 8.5% of the students consumed fish, based on estimated EPA (eicosapentaenoic acid) + DHA (docosahexaenoic acid) intakes. Adolescents who consumed fish had higher intake of protein, water, B vitamins, magnesium, selenium, and zinc but consumed more calories, fat, saturated fat, and sodium. Considering the school health program's potential to reach adolescents, more intensive school-based interventions can be directed to promote safe fish consumption and to encourage other positive lifestyle behaviors.

Perceptions of how parents of early adolescents will personally benefit from calcium-rich food and beverage parenting practices.

OBJECTIVE: To identify and rank perceived personal benefits from parenting practices that promote intake of calcium-rich foods and beverages (CRF/B) by early adolescents. METHODS: A convenience sample of parents/caregivers (n = 133) of early adolescents (10-13 years) from 6 states (CA, HI, MN, OH, OR, UT) participated in a qualitative study using a Nominal Group Technique process. Benefits identified by parents/caregivers were ranked by importance, given a score weight, and summed to create a total weighted score across states. RESULTS: The top benefit from making CRF/B available was parent emotional rewards. The top benefit perceived by parents from role modeling intake of CRF/B and setting expectations for intake of CRB was child health promotion. CONCLUSIONS AND IMPLICATIONS: Child health promotion and parent emotional rewards were important perceived benefits derived from CRF/B parenting practices, and thus, should be included as the focus of education to increase the frequency of these practices.

Use of Fish Oil-Based Lipid Emulsions in Infants With Intestinal Failure-Associated Liver Disease: A Case Series.

The use of fish oil-based lipid emulsions (FOLE) in the treatment of intestinal failure-associated liver disease (IFALD) remains investigational. Additional evidence for safety and efficacy, particularly in the neonatal and pediatric populations, is needed. Retrospective chart review was conducted on 10 infants with short bowel syndrome who received FOLE for IFALD. Direct bilirubin concentrations normalized in surviving subjects within 4.1 to 22.7 weeks of starting treatment. Although earlier initiation of FOLE was not associated with more rapid normalization of direct bilirubin concentrations, it trended toward a significant correlation with reduced length of hospital stay (P = .058). The reduction in direct bilirubin levels and transition from parenteral to enteral feeding were statistically significant within 6 weeks of initiating the FOLE. Subjects did not have impaired growth and did not develop an essential fatty acid deficiency. These infants were discharged from the hospital 7.9 to 42.3 weeks after starting FOLE treatment, and 2 infants had transitioned completely off parenteral nutrition at discharge. In this study, FOLE appeared to be a safe and effective treatment for IFALD in infants with short bowel syndrome. Future studies are necessary to determine whether FOLE can help to prevent or shorten the duration of cholestasis.

Estimation of fish intake in Asian and white female adolescents, and association with 2-year changes in body fatness and body fat distribution: the female adolescent maturation study.

BACKGROUND: Fish is an important source of long-chain n-3 fatty acids in the diets of female adolescents, which may affect adipose tissue deposition. OBJECTIVE: The purpose of this study was to evaluate fish intake in Asian and white female adolescents, and to determine whether fish intake was associated with changes in body fatness and body fat distribution in this population. DESIGN: A cross-sectional analysis of fish intake using 3-day food records (n=200), and a prospective analysis of baseline fish intake on anthropometric measurements 2 years later was conducted (n=103). PARTICIPANTS/SETTING: Participants included female adolescents (aged 9 to 14 years) who were recruited from the Kaiser Permanente Oahu membership database in 2000-2001 as part of the Female Adolescent Maturation study (N=349). STATISTICAL ANALYSIS: Fish intake and the proportion of participants eating 8 oz fish per week was compared between Asian, white, and mixed Asian/white ethnic groups using Kruskal-Wallis test, Wilcoxon rank sum test, and χ(2) test, respectively. The effect of fish intake on anthropometric measurements was assessed using Spearman's rank correlation coefficient and linear regression analyses, adjusting for demographic, pubertal, anthropometric, activity, and dietary parameters. RESULTS: Asians consumed more fish (0.85 oz/wk [range=0.00 to 4.74 oz/wk]) than whites (0.00 oz/wk [0.00 to 0.40 oz/wk]; P=0.0001), and were more likely to eat 8 oz fish per week (13 of 68 vs 2 of 51, respectively; P=0.014). Greater fish intake corresponded to smaller changes in waist circumference when controlling for age, ethnicity, puberty, activity, energy intake, and baseline waist circumference (P=0.026), but not after adjusting for parental and additional dietary parameters (P>0.10). CONCLUSIONS: Most female adolescents did not consume the recommended amount of fish, a problem that was more common in whites than Asians. The protective effect of fish intake on abdominal obesity warrants further study.

Estimation of fish and ω-3 fatty acid intake in pediatric nonalcoholic fatty liver disease.

AIMS: Fish and ω-3 fatty acids are reported to be beneficial in pediatric nonalcoholic fatty liver disease (NAFLD), but no studies have assessed their relation to histological severity. The objectives of this study were to evaluate the dietary intake of fish and ω-3 fatty acids in children with biopsy-proven NAFLD, and examine their association with serological and histological indicators of disease. METHODS: This was a cross-sectional analysis of 223 children (6-18 years) who participated in the Treatment of Nonalcoholic Fatty Liver Disease in Children trial or the NAFLD Database study conducted by the Nonalcoholic Steatohepatitis Clinical Research Network. The distribution of fish and ω-3 fatty acid intake was determined from responses to the Block Brief 2000 Food Frequency Questionnaire, and analyzed for associations with serum alanine aminotransferase, histological features of fatty liver disease, and diagnosis of steatohepatitis after adjusting for demographic, anthropometric, and dietary variables. RESULTS: The minority of subjects consumed the recommended 8 ounces of fish per week (22/223 [10%]) and 200 mg of long-chain ω-3 fatty acids per day (12/223 [5%]). Lack of fish and long-chain ω-3 fatty acid intake was associated with greater portal (P = 0.03 and P = 0.10, respectively) and lobular inflammation (P = 0.09 and P = 0.004, respectively) after controlling for potential confounders. CONCLUSIONS: Fish and ω-3 fatty acid intake was insufficient in children with NAFLD, which may increase susceptibility to hepatic inflammation. Patients with pediatric NAFLD should be encouraged to consume the recommended amount of fish per week.

Liver disease among children in Hawai'i diagnosed with metabolic syndrome.

The purpose of this study was to evaluate the prevalence of and factors related to liver disease among children in Hawai'i with metabolic syndrome. The medical charts of children diagnosed with metabolic syndrome by an outpatient endocrinologist between January 2000 and December 2010 were reviewed. Liver disease prevalence was estimated based on serum alanine aminotransferase (ALT) levels, which were then assessed for associations with demographic (age, gender, ethnicity), anthropometric (body mass index), biochemical (fasting blood glucose, hemoglobin A1c, triglycerides, and total, LDL- and HDL-cholesterol), and clinical (blood pressure) characteristics of subjects. Serum ALT was available for 167 of the 195 subjects. The proportion of subjects with liver disease (105/167 [63%]) was greater than many traditional features of metabolic syndrome including hypertriglyceridemia (73/177 [41%]), hypertension (37/194 [19%]) and hyperglycemia (37/170 [22%]). Serum ALT values were positively associated with age (P=.030), and liver disease was more common among boys than girls (62/91 [68%] vs 43/76 [57%]), although this difference was not statistically significant (P=.123). There was a significant difference in liver disease across ethnicities (P=.029), and appeared to be more common in children with Pacific Islander surnames (14/16 [88%]), and less common in children with Hispanic surnames (7/20 [35%]). Diastolic blood pressure was the only obesity-related disease parameter associated with serum ALT after adjusting for age and gender (P=.018). In conclusion, liver disease was common among children diagnosed with metabolic syndrome in Hawai'i. Age, gender, and ethnicity may be important determinants of liver disease risk, and should be investigated further.

The effect of weight loss on pediatric nonalcoholic Fatty liver disease.

This study evaluated the effect of weight loss on pediatric nonalcoholic fatty liver disease (NAFLD). Subjects included 81 overweight NAFLD patients referred to two pediatric gastroenterologists from 2000 to 2010. Data on subjects were obtained from review of medical charts. The effect of weight loss was assessed at 1-4 months, 5-8 months, 9-12 months, and beyond one year as the change in weight, BMI z-score (for age-and-sex), and alanine aminotransferase and the relationship between the change in body weight and BMI z-score, and the change in alanine aminotransferase. Subjects were mostly obese (99%), male (86%), and Asian (63%) and had median age of 14.1 (11.2-16.2) years and alanine aminotransferase of 105 (78-153) U/L at referral. Alanine aminotransferase decreased 32 ± 66 (P = 0.016), 30 ± 65 (P = 0.134), 37 ± 75 (P = 0.0157), and 45 ± 69 (P = 0.014) for subjects with follow-up data at 1-4 months (n = 47), 5-8 months (n = 26), 9-12 months (n = 19), and beyond one year (n = 19), respectively. During these time periods, neither was body weight (-0.2 to +7.1 kg) or BMI z-score (-0.12 to -0.05) significantly reduced, nor were changes in these variables associated with the change in alanine aminotransferase. These findings suggest that weight and BMI z-score may not be sufficient indicators of treatment response in pediatric NAFLD patients.

Prices of healthy and unhealthy beverages in high and low per capita income areas.

To better understand availability and price of beverages in Hawai'i, the prices of healthy (milk, orange juice, unsweetened tea, unsweetened coffee, diet soda) and unhealthy beverages (regular soda, fruit drink, sports drink, sweetened tea, flavored water) were collected and the beverage prices in lower per capita income areas and higher per capita income areas were compared. Cross-sectional data on prices of healthy and unhealthy beverages were collected from supermarkets, convenience stores, and quick serve restaurants from two lower per capita income areas (Waimanalo and Wai'anae) and two higher per capita income areas (Hawai'i Kai and Manoa) on O'ahu, Hawai'i from May 15 to June 10, 2012. Using composite data from across all areas, there was a significant difference of $0.58 (95% CI 0.46, 0.70) between the healthy beverages' mean price per 20 ounces ($1.76 ± $0.86) and the unhealthy beverages' mean price per 20 ounces ($1.18 ± $0.38) (P <.001). Although there was no statistically significant difference between per capita income areas, the lower per capita income areas' mean price per 20 ounces of healthy beverages was slightly higher and mean price per 20 ounces of unhealthy beverages was slightly lower than the higher per capita income areas. Pricing strategies that enable healthy beverages to be less expensive than unhealthy beverages is one method to increase consumption of healthy beverages and decrease consumption of unhealthy beverages. Reduction in unhealthy beverage consumption is needed to help reduce obesity, especially in the lower per capita income areas that have higher obesity prevalence.

Meal composition and shift work performance.

Research indicates that the ability to perform a task can be affected by the composition of the meal preceding the task. This study investigated the effect of shift workers' consumption of a medium-fat, medium-carbohydrate meal on alertness scores. Six subjects (four men, two women) aged 19 to 44 recorded food intake, sleep, and quality of sleep for two weeks, and measured their body temperature and performed cognitive tests during two night shifts at baseline and in test periods. The Stanford Sleepiness Scale (SSS) was used to quantify sleepiness, and a Paced Auditory Serial Addition Test (PASAT) was used to measure cognitive performance. In comparison with the score at baseline, when subjects had a low-fat, high-carbohydrate dietary intake (1,335 kcal/5,588 kJ, 56% carbohydrate, 28% fat), the 1.6-second PASAT score improved significantly (p=0.042) during night shifts when subjects consumed a test meal (987 kcal/4,131 kJ, 46% carbohydrate, 42% fat). No statistically significant difference in SSS was found between baseline and test periods. The reduced body temperature between 2400 hours and 0530 hours was similar for both baseline and test periods. Meal composition and size during night shifts may affect cognitive performance.

Exploring patient satisfaction with foodservice through focus groups and meal rounds.

The purpose of this study was to investigate adult patients' perceptions of hospital foodservice through focus groups with patients postdischarge and with nurses. The focus group themes included an emphasis on health, quality, freshness, and appropriateness; variety, selection, and choice; inability to provide feedback; menu errors; accessibility to food on the units; service; tray layout; and waste. The themes emerging from the focus groups were further explored through meal round interviews with patients (n=116) to determine areas for improvement. Patients thought food served in the hospital should be a model for a healthy diet. Ongoing education and communication with patients and nurses is important in improving satisfaction with foodservice.